Vomiting Blood
Vomiting blood, medically known as hematemesis, is a serious symptom indicating bleeding somewhere in the upper digestive tract. Whether appearing as bright red blood or dark "coffee grounds," this symptom always requires immediate medical evaluation. The amount and appearance of blood can provide clues about the source and severity of bleeding.
🚨 MEDICAL EMERGENCY - Call 911 Immediately For:
- Any amount of blood in vomit
- Coffee-ground appearance vomit
- Vomiting blood with dizziness or weakness
- Rapid pulse or low blood pressure
- Pale, clammy skin
- Confusion or altered consciousness
- Severe abdominal pain
- Black, tarry stools (melena)
- History of liver disease or alcohol abuse
- Recent use of blood thinners
- Chest pain or difficulty breathing
DO NOT WAIT - Vomiting blood can indicate life-threatening bleeding that requires immediate emergency treatment.
Understanding Hematemesis
Hematemesis refers to the vomiting of blood originating from the upper gastrointestinal tract, including the esophagus, stomach, or upper small intestine. The blood may appear bright red, indicating fresh bleeding, or resemble coffee grounds when partially digested by stomach acid. Even small amounts of blood in vomit warrant immediate medical attention.
The severity ranges from minor bleeding that stops on its own to massive hemorrhage that can be life-threatening within minutes. The color and consistency of the blood provide important diagnostic clues: bright red blood suggests active, recent bleeding, while dark, coffee-ground material indicates older blood that has been in contact with stomach acid.
Common Causes
Peptic Ulcer Disease
- Stomach ulcers
- Duodenal ulcers
- H. pylori infection
- NSAID-induced ulcers
- Stress ulcers
- Perforated ulcer
Esophageal Causes
- Esophageal varices
- Mallory-Weiss tear
- Boerhaave syndrome
- Severe GERD
- Esophagitis
- Esophageal cancer
Other GI Causes
- Gastritis
- Stomach cancer
- Dieulafoy lesion
- Gastric varices
- Angiodysplasia
- Portal hypertensive gastropathy
Systemic Causes
- Bleeding disorders
- Blood thinning medications
- Liver disease/cirrhosis
- Kidney failure
- Blood vessel disorders
- Severe vomiting (tears)
Blood Appearance and Meaning
Bright Red Blood
- Fresh, active bleeding
- Usually from esophagus or stomach
- May indicate arterial bleeding
- Often more urgent
Coffee-Ground Appearance
- Older blood exposed to stomach acid
- Dark brown or black color
- Grainy texture
- Still requires emergency care
Mixed with Food
- May appear pink or red-tinged
- Can mask severity
- Still concerning
- Requires evaluation
Associated Warning Signs
Vomiting blood often occurs with other symptoms indicating severity:
- Shock symptoms: Rapid pulse, low blood pressure
- Abdominal pain: Location and severity vary
- Black stools: Indicates GI bleeding
- Weakness/dizziness: From blood loss
- Sweating: Cold, clammy skin
- Confusion: Reduced blood flow to brain
- Chest pain: Possible heart strain
- Difficulty swallowing: Esophageal issues
Risk Factors
- Chronic alcohol use: Liver disease, varices
- NSAID use: Aspirin, ibuprofen
- Blood thinners: Warfarin, newer anticoagulants
- Previous ulcers: Recurrence risk
- Liver disease: Portal hypertension
- H. pylori infection: Ulcer formation
- Smoking: Impairs healing
- Severe stress: ICU patients
Emergency Treatment
Immediate Hospital Care
- IV fluids for volume replacement
- Blood type and crossmatch
- Blood transfusions if needed
- Proton pump inhibitors IV
- Correction of clotting abnormalities
- Continuous monitoring
Diagnostic Procedures
- Upper endoscopy: Visualize and treat bleeding
- Blood tests: Hemoglobin, clotting studies
- CT angiography: If endoscopy negative
- Nasogastric lavage: Assess active bleeding
Treatment Options
- Endoscopic therapy (cautery, clips, injection)
- Variceal banding or sclerotherapy
- Angiographic embolization
- Surgery for severe cases
- TIPS procedure for varices
What to Do While Waiting for Help
- Call 911 immediately: Don't drive yourself
- Stay calm: Anxiety increases heart rate
- Sit upright: Prevents aspiration
- Nothing by mouth: No food or water
- Save vomit sample: If safely possible
- List medications: Especially blood thinners
- Note symptoms: Timing and amount
- Have someone stay: Don't be alone
Prevention Strategies
- Treat H. pylori: If infected
- Limit NSAIDs: Use alternatives when possible
- Manage GERD: Reduce acid reflux
- Alcohol moderation: Prevent liver disease
- Regular screening: If at risk
- Medication review: With doctor
- Stress management: Reduce ulcer risk
- Follow-up care: After any GI bleeding